In response to the Health Select Committee's
announcement of an inquiry into Public Health, I am writing with
Lloydspharmacy's view of the role of pharmacies in supporting
public health within communities by working with local bodies
such as councils and health authorities, and within new organisational
arrangements such as Health Action Zones, Education Action Zones
and Healthy Living Centres.

I hope this will provide some insight into the
way that these bodies and arrangements work while suggesting,
as your terms of reference put it, an "alternative model"
of public health provision: in our view, this being one which
gets better value out of pharmacists than at present.

In this respect, I also hope you will consider
formally extending your examination of the co-ordination between
public bodies and structures to those elements of the private
sector which exist in the main to service the public sector, pharmacy
being a leading example.

1. INTRODUCTIONTO LLOYDSPHARMACY

Lloydspharmacy is the largest community operator
in the UK, with over 1,300 pharmacies located mainly in community
and health centre locations. Without sister pharmaceutical wholesaling
company, AAH Pharmaceuticals, which as 17 warehouses across the
UK, we have a combined turnover of £4 billion and 18,000
employees nationwide.

Our growth strategy is based on delivering superior
personal healthcare advice and service in communities, working
together with local groups to maximum effect. We offer:

 a unique awareness of "social
pharmacy";

 active support for Government disease
priorities;

 a first-class dispensing service;

 prescription counselling advice to
encourage medicines compliance;

 a prescription collection and delivery
facility for the housebound/disabled;

 a broad range of 25,000 items, including
own brand products and "homecare" products for people
with disabilities; and

 a solution to providing GPs with
new practice facilities, incorporating an integral pharmacy.

We are industry leaders in pharmacists' training
programmes and community health initiatives, and the leading community
pharmacy providers in health centres.

2. RECOMMENDATIONS

There is a great deal that pharmacies can do
to bring those concerned with public health and to help new public
health arrangements to work. Local health and well being would
benefit from greater recognition of this role. Encouraging pharmacies
to provide a wide range of health and social information and advice
would also help ensure consistency between the health messages
given to people of different backgrounds.

Lloydspharmacy is probably unique in its focus
on "social pharmacy". We believe pharmacists' training
and positioning in local communities equip them to do more for
people's health than dispense medicines, important though this
is with accompanying advice and counselling. The concept of medicine
management, orchestrated and facilitated by pharmacists, will
allow maximisation of the drugs budget and deliver cost effective
health gains. However, pharmacists are also equipped to play a
greater role with other groups working to improve public health.

"Social pharmacy" works. It adds value
to other public health efforts and creates new possibilities.
We would thus urge the Committee to recommend the following steps
to the Government:

Formally include pharmacy as a matter of course
among the key local bodies which work together to support public
health.

This would enable a wider variety of health
and social messages to be communicated to the public. In many
areas, pharmacy has to fight to get its voice heard where others
simply stroll to the table. This is effectively a misuse of resource,
which can be very easily rectified.

Incentivise pharmacists to provide a wide range
of health and social information and advice by re-engineering
the pharmacy remuneration system.

Sadly, Lloydspharmacy's "social pharmacy"
approach is the exception rather than the rule; a response to
our feeling that someone has to demonstrate pharmacy's potential.
As, effectively, an experiment, a pilot study of the "social
pharmacy" theory in practice is not a contributor to the
bottom line profits, it cannot continue indefinitely within the
current remuneration system. The current system rewards pharmacists
for keeping patients on long-term medication rather than helping
them in other ways. Unless this system is changed, the opportunity
to spread the "social pharmacy" approach and reduce
pressure on GPs will eventually be lost.

Support prevention by encouraging early testing
in pharmacies: this would require financial support to encourage
wider provision and take-up.

Good public health results largely from effective
prevention. Most people who visit a GPs surgery are already ill.
To encourage prevention, those who are well need to have easier
access to, and encouragement to undertake, tests which enable
disease to be detected and treatment given at an earlier stage.
This will both reduce pressure on GPs and result in long-term
secondary care savings.

Pharmacies provide an obvious point of access
to this early testing. Currently, most testing is paid for by
the patient and is, therefore, neither offered nor taken up as
widely as it might be.

3. LLOYDSAND
SOCIAL PHARMACY

Social, economic and environmental factors all
affect people's health. Lloydspharmacy believes that the best
way of dealing with them is through multi-disciplinary team working.
Community pharmacies have a major role here. Not only do they
provide a non-threatening, accessible environment for the public,
but they can also bring together a range of interests.

Yet this role is not generally accepted. The
result is under-utilisation of highly qualified members of the
healthcare team. Pharmacists undergo five years of training before
they qualify: a four-year undergraduate course, followed by a
year's postgraduate experience. Besides the fundamentals, such
as chemistry and pharmacology, their courses increasingly focus
on social issues; for example, the interaction with the healthcare
team and how to encourage customers to talk about their condition
to ensure they are given the right treatment.

There is much the Government could do to achieve
better use of pharmacists, starting with the recommendations we
make above.

In the absence of formal action to date, however,
Lloydspharmacy has decided itself to undertake what is effectively
a unique experiment in "social pharmacy" (the term we
use to describe the involvement of pharmacies in a multi-agency
approach to improving public health). Our aim is to show in practice
the benefits of involving pharmacists more closely in the work
of local bodies on improving public health.

In the appendix to this letter, taken from Lloydspharmacy's
own experience, we show social pharmacy working together with
other healthcare players such as Government departments, local
councils, the NHS and schools to achieve an improved level of
public health.

I hope the Health Select Committee will find
the ideas set out here of interest to its work. Please do not
hesitate to contact me if you would like further details on any
aspect of this submission.